The Surgical Treatment of the Cervical Myelopathy with Laminectomy and Posterior Fusion by using Lateral Mass Screw Fixation

Kyung-Soo Suk; Ki-Tack Kim; Jung-Hee Lee; Sang-Hun Lee; Jin-Soo Kim; Jae-Hyung Uh

doi:10.4055/jkoa.2009.44.1.123

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Suk, Kim, Lee, Lee, Kim, and Uh: The Surgical Treatment of the Cervical Myelopathy with Laminectomy and Posterior Fusion by using Lateral Mass Screw Fixation

Original Article

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2009; 44(1): 123-129.

Published online: 23 February 2009

DOI: https://doi.org/10.4055/jkoa.2009.44.1.123

The Surgical Treatment of the Cervical Myelopathy with Laminectomy and Posterior Fusion by using Lateral Mass Screw Fixation

Kyung-Soo Suk, M.D., Ki-Tack Kim, M.D., Jung-Hee Lee, M.D., Sang-Hun Lee, M.D., Jin-Soo Kim, M.D.^*, Jae-Hyung Uh, M.D.

Department of Orthopaedic Surgery, Kyung Hee University College of Medicine, Seoul, Korea.

^*Department of Orthopaedic Surgery, Seoul Medical Center, Seoul, Korea.

Address reprint requests to Jung-Hee Lee, M.D. Department of Orthopaedic Surgery, Kyung Hee University College of Medicine, 1, Heogi-dong, Dongdaemun-gu, Seoul 130-702, Korea. Tel: +82.2.958.8345, Fax: +82.2.964.3865, sks111@khmc.or.kr

Abstract

Purpose

This prospective study was designed to investigate the outcomes of laminectomy and fusion with using lateral mass screw (LMS) fixation for the treatment of cervical myeolpathy.

Materials and Methods

We studied a series of 26 consecutive patients with cervical myelopathy and who were planned to undergo laminectomy and fusion with using LMS fixation. MRI was done to investigate the high signal intensity lesion (HSIL) in the cord on the T2 weighted sagittal images. The JOA score, the grip and release test, the finger escape sign, and Hoffman's sign were checked. We analyzed the clinical outcomes depending on the high signal intensity lesion in the cord, the preoperative kyphosis, and the preoperative instability.

Results

The indications for lateral mass screw fixation was kyphotic deformity, segmental instability or ossification of the ligament flavum (OLF). Patients with HSIL on the T2-weighted sagittal MRI was found in 17 patients. The JOA score, the grip and release test, and the finger escape sign were significantly improved after the operation and at the 2 year follow up. The patients with HSIL on the T2-weighted sagittal MRI or segmental instability had a significantly lower preoperative JOA score and a poor postoperative recovery as assessed by the JOA score.

Conclusion

Laminectomy and fusion using lateral mass screw fixation for the surgical treatment of cervical myelopathy, which is associated with kyphotic deformity, instability or OLF, is considered a safe and effective treatment option to prevent postoperative kyphosis.

Keywords: Cervical spine, Laminectomy, Lateral mass screw fixation, Myelopathy, Posterior fusion

Figures and Tables

Fig. 1

A 60-year-old man who had cervical myelopathy. Preoperative cervical spine lateral radiographs show 5.4° hypolordosis in neutral postion (A), 22.5° kyphosis in flexion (B), and 8.9° lordosis in extension (C). Preoperative MR image (D). Postoperative and 2-year follow up cervical spine lateral radiograph shows recovery of lordosis.

Fig. 2

A 59-year-old man who had cervical myelopathy caused by cervical spondylotic myelopathy with kyphosis. Preoperative cervical spine lateral radiograph shows 10.9° kyphosis in neutral position (A), 24.2° kyphosis in flexion (B), and 0.5° kyphosis in extension (C). Preoperative MR image (D). Postoperative and 2-year follow up cervical spine lateral radiograph shows recovery of lordosis.

Table 1

Clinical Features and Surgical Outcomes with or without High Signal Intensity Lesion (HSIL) on T2-weighted MR Image

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